Mixed-Method Follow-Up of Toddler-Aged Children with Spastic Cerebral Palsy After an Intense Physical/Occupational...

A plethora of articles report the effectiveness of many different interventions for managing cerebral palsy (CP), but there are few long-term follow-up studies of children after an intervention designed to improve function in children with CP. This observational mixed-methods study examined the functional gains observed more than one year after toddlers completed a 48-week investigation that included 5 days per week for 12 weeks of occupational and physical therapy using the Perception-Action Approach (P-AA). The aim was to observe whether the functional gains made by the children continued to improve, plateaued, or declined at long-term follow-up.

The sample was 23 children with a mild-to-moderate level of CP (Gross Motor Function Classification System I, II, or III) who completed the original study at least one year prior. The follow-up assessment included quantitative data using the Gross Motor Function Measure-66 (GMFM) and the Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS). Seventeen of 23 children were evaluated with both instruments. Qualitative data were collected from 14 of the 23 families who completed the PEDI-FS. Those families completed a survey with an open-ended questionnaire that assessed the caregivers' perspectives about their children's functioning and the impact of the intervention.

Findings from the quantitative data based on prognostic GMFM-66 developmental curves by age for children with CP: seven of the 17 children who had GMFM evaluations showed greater than expected improvement (all 5 with GMFCS II), four met the expected improvement, and six did not. Children with GMFCS II or III maintained their positions relative to the mean on the PEDI-FS mobility subset. Findings from the qualitative data revealed that some parents believed the intervention contributed to the changes in their children's physical, mental, and social functioning. Many parents indicated that the study helped them overcome financial barriers related to accessing intensive therapies. Most parents reported that their child's functioning was better than they expected when given the diagnosis of CP.

Many months following an intense physical and occupational therapeutic intervention, based on predicted age-appropriate percentiles for motor function, roughly one-third of the children exceeded expectations, and one-third did not meet expectations. Despite the time invested in the intense protocol, caregivers felt the intervention was largely responsible for improvements in their children's functioning.